Linking Tele-Health & Parish Nursing in Affordable Housing

1. Linking Tele-Health & Parish Nursing in Affordable Housing

2. Learning Objectives • Learn how technology can be used as a tool to improve the general wellbeing of your residents • Discover why Parish Nursing is so important to the holistic approach to Wellness. • Learn how the Service Coordinator and Parish Nurse collaborative works to increase participation by residents and community members.

3. Telehealth Technology

4. Telehealth Technology

5. Telehealth Technology & Parish Nursing • Health Education • Providing referrals • Calling/faxing Primary Care Physicians • Avoiding hospitalizations • Spiritual Care • Empowerment of self care

6. Service Coordinator/Parish Nurse Collaboration • Unified efforts to same goals: • Creating awareness of program • Educating resident and community members about kiosk • Empowerment to better self health and quality of life

7. Service Coordinator/Parish Nurse Collaboration • Parish Nurses and Service Coordinators work collaboratively to: • Survey health knowledge and needs • Provide exercise opportunities • Prevent social isolation • Opportunities that support spiritual fulfillment

8. Health Topic Presentations

9. Community Outreach • sH Health Screenings • & • Health Awareness

10. Numbers of Lives Touched • With the grant, it was proposed that 380 unduplicated residents would use the kiosk annually. • We did not anticipate the huge success of resident participation! • Parish Nurses are seeing 13-25 residents in one 8 hour shift • To date, the kiosk has been visited 15,045 times and the nurses have had 12,159 consultations with residents and community members! • There have been 3,789 resident interventions and 3,949 interventions counting community members. • Since the start the kiosk has had 19,071 readings

11. Success Stories

12. Success Story: Blood Pressure and Shoes

13. Success Story: Avoided Hospitalization

14. Success Story: Spiritual Care

15. Success Stories • Nurse Debbie identified a resident who had a very low, irregular heartbeat of a resident who is 99 years-old. The nurse reported her concern to the residents doctor and the nurse, doctor and resident are working together, monitoring the resident to prevent complications. • Nurse Debbie holds a “Joy in Motion” class at 3 of the communities, teaching stretching, yoga and tai chi from the chair. During this session she discusses different health topics such as the benefits of checking their glucose, right things to eat, high blood pressure, etc. to which several residents attend to help them maintain good control of their weight, blood pressure, and blood sugar levels. It also helps with their flexibility, socialization , and overall well being.

16. Helping Older Adults Live Life to the Fullest

38. MALNUTRITION DEFINED Malnutrition is faulty or inadequate nutrition, poor nourishment resulting from insufficient food, improper diet

39. TRUE OR FALSE Underweight elders are at higher risk of death than those who are overweight.

40. ANSWER TRUE Malnutrition is associated with many acute and chronic illnesses, including anemia, edema, confusion, orthostatic hypotension, and falls, <in immune function, >drug interactions, and significant risk for development of pressure ulcers.

41. STATE REGULATIONS: NUTRITION DHSS- 19CSR-30-85.052 PLEASE TURN TO APPENDIX D • 3 MEALS DAILY—2MUST BE SERVED HOT • MUST OFFER NUTRITIONAL VALUE AND FLAVOR • SPECIAL ATTENTION GIVEN TO TEXTURE • HOT FOOD HOT AND COLD FOOD COLD • SUBSTITUTES OFFERED • NOURISHING BEDTIME SNACKS OFFERED • TRAY AND DINING ROOM SERVICE SHALL BE ATTRACTIVE AND APPROPRIATE • SHALL BE ABLE TO EAT COMFORTABLY (TRAY/ TABLE)

42. DHSS- 19CSR-30-85.052 Cont. • ESTABLISHED MEAL TIMES • 30 MIN. OR AS LONG AS NECESSARY TO FINISH • MUST BE ABLE TO I.D. RESIDENT WITH DIET ORDERED • ALTERNATIVE MEAL SERVICE OFFERED (BEHAVIORS) • SUFFICIENT PERSONNEL, PROPERLY TRAINED • RESPONSIBLE DIETARY SUPERVISOR TO OVERSEE • SPECIAL PRESCRIBED DIETS SHALL BE REVIEWED • ALL REGS GOVERNING SANITATION (13CSR 15-17) • WHEN UNABLE TO MEET NEEDS OF COMPLEX DIET

43. DHSS- 19CSR-30-85.052 Cont. • CURRENT RECORD OF PURCHASED FOOD • SUPPLIES OF STAPLE FOOD ITEMS 1 WEEK/ 3 DAY • MINIMUM OF 2 WEEK ADVANCE MENUS PLANNED • A FILE OF STANDARD RECIPES SHALL BE USED • DIV. OF AGING DIET MENU READILY AVAILABLE TO PHYSICIANS, NURSES, AND DIETARY PERSONNEL

44. FEDERAL REGULATIONS: NUTRITION PLEASE TURN TO APPENDIX D (F-310) • ADL’S DO NOT DIMINISH UNLESS CLINICALLY UNAVOIDABLE (TO INCLUDE ABILITY TO EAT) CONDITIONS WHICH MAY DEMONSTRATE UNAVOIDABLE DIMUNITION IN ADL’S ARE AS FOLLOW: • NATURAL PROGRESSION OF DISEASE • REFUSAL OF FACILITY’S EFFORTS TO OFFER OR ALTERNATIVES • (BE SURE TO DOCUMENT ALL INTERVENTIONS) ***IF A SURVEY TEAM IDENTIFIES A PATTERN OF DETERIORATION IN MORE THAN 1 ADL’S IN A RESIDENT OR 1 ADL IN SEVERAL RESIDENTS IT IS DETERMINED DEFICIENT PRACTICED AND CITED AS SUCH (F-310)

45. FEDERAL REGULATIONS: NUTRITION • F-312 A RESIDENT UNABLE TO CARRY OUT ADL’S MUST RECEIVE NECESSARY SERVICES • METHODS OF GOOD NUTRITION MAY INCLUDE: • HAND FEEDING OF FOODS • TUBE FEEDING THROUGH NASO-GASTRIC, GASTROSTOMY, OR TPN

46. FEDERAL REGULATIONS: NUTRITION • F-325 • The facility must ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident’s clinical condition demonstrates that this is not possible and 483.25(i)(2) Receives a therapeutic diet when there is a nutritional problem.

47. MEASURING PARAMETERS • Labatory/ Diagnostic evaluation may help to identify any underlying causes. i.e. Albumin and Pre-albumin. • Parameters for evaluating significance of unplanned and undesired weight loss: • IntervalSignificant LossSevere Loss • 1 month 5% Greater than 5% • 3 months 7.5% Greater than 7.5% • 6 months 10% Greater than 10% The following formula determines the % of weight loss % of body weight loss= (usual weight-actual weight) / (usual weight ) x 100

48. SURVEYING PARAMETERS F325 • ACCEPTABLE PARAMETERS factors that reflect that an individual’s nutritional status is adequate • WHEN ACCEPTABLE PARAMETERS ARE NOT MET • AVOIDABLE- WHEN RESIDENT DOES NOT MEET AP BECAUSE THE FACILITY FAILED TO: • EVALUATE RESIDENT’S CLINICAL & NUTRITIONAL RISK • DEFINE & IMPLEMENT INTERVENTIONS CONSISTENT W/ NEEDS • MONITOR IMPACT OF INTERVENTIONS • UNAVOIDABLE- WHEN DESPITE THE FACILITIES EFFORTS TO DO ALL THE ABOVE… THE RESIDENT STILL SLIPS BELOW ACCEPTABLE PARAMETERS

49. F-325 NON- COMPLIANCE = FURTHER CONCERNS AND TAGS Tag F353 Sufficient Staff Tag F361 Dietary Services Staffing Tag F362 Standard Sufficient Staff Tag F385 Physician Services- Physician Supervision Tag F500 Use of Outsider Resources Tag F501 Medical Director Tag F520 Quality Assessment & Assurance Tag F150 Resident Rights Tag F272 Assessments Tag F279 Care Plans Tag F280 Care Plan Revision Tag F282 Provision of Care in Accordance of Care Plan Tag F327 Hydration Tag F328 Special Needs Tag F329 Unnecessary Medicines

50. RESEARCH & STATISTICS • STRONG CORRELATION B/T WT. LOSS, MORBIDITY, & MORTALITY • RESEARCH: RESIDENTS WHO LOST 5% BW IN 1 MONTH WERE 4 X MORE LIKELY TO DIE IN 1 YR. • 5%= SIGNIFICANT PREDICTOR OF DEATH • 54% OF LTC RESIDENTS ARE POTENTIALLY MALNOURISHED • MALNUTRITION HAS PROVEN TO LEAD TO • PRESSURE ULCERS • GENERAL HEALTH IMPAIRMENT • INFECTION • OTHER DISEASES